OBJECTIVES: To investigate the relationship between very low birth weight and learning difficulties at school by means of a systematic review of the literature, identifying patterns of learning difficulties among these schoolchildren, possible cognitive correlations, peculiarities of the lowest birth weight ranges and any interference with outcomes by socioeconomic and/or clinical factors. SOURCES OF DATA: Bibliographic search (MEDLINE, LILACS, Excerpta Medica, reference lists of original articles, periodicals related to the subject, information from experts in the area and thesis and dissertation databases) on the keywords: prematurity/very low birth weight, learning difficulties/academic achievement/school performance, follow-up/results/cohort. SUMMARY OF THE FINDINGS: The search returned 114 articles and the 18 of these were selected as having investigated learning difficulties in schoolchildren born with very low birth weights using appropriate methodology. The academic performance of these children was observed to be inferior the whole study population was compared with those born full term. The subject most compromised was mathematics. The risk of suffering from learning difficulties increased in inverse proportion to birth weight. An association was identified between very low birth weight and cognitive compromise. CONCLUSIONS: The systematic approach corroborated the results obtained by published studies: schoolchildren born with very low birth weights exhibited increased risk of learning difficulties when compared with those born at full term. There was a predominance of children with multiple academic subjects compromised and mathematics was the most affected. Risk was observed to follow an ascending gradient as birth weight reduced. There was an association between very low birth weight and cognitive compromise.